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Abstract Number: 1034

The Part Of Function (Health assessment Questionnaire) In The SF-6D and EQ-5D Utility Measures Varies Over Time In Early Arthritis (ESPOIR cohort): Questionable Validity Of Deriving Quality Adjusted Life Years From HAQ

Cécile Gaujoux-Viala1, Anne-Christine Rat2, Kossar Hosseini3, Rene-Marc Flipo4, Francis Guillemin3 and Bruno Fautrel5, 1EA 2415, Montpellier I University, Nîmes University Hospital, Rheumatology Department, Nîmes, France, 2Université de Lorraine, Nancy, F-54000, France; Inserm, CIC-EC CIE6, Nancy, F-54000, France; CHU de Nancy, Clinical Epidemiology and Evaluation Department, Nancy, F-54000, France; CHU de Nancy, Rheumatology department, Nancy, France, 3CHU Nancy, Clinical Epidemiology and Evaluation, Université de Lorraine, Paris Descartes University, APEMAC, EA 4360, Nancy, France, 4Rheumatology, University Hospital Lille, Lille, France, 5Paris 6 – Pierre et Marie Curie University; AP-HP, Rheumatology, Pitié-Salpêtrière Hospital, - GRC-UPMC 08 – EEMOIS, Paris, France

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Early Rheumatoid Arthritis, economics and quality of life

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Session Information

Session Title: Epidemiology and Health Services II & III

Session Type: Abstract Submissions (ACR)

Background/Purpose: There is growing emphasis on the cost-effectiveness of treating early arthritis (EA). As few studies directly record the utility measures needed for economic analyses, mapping is often used. Health Assessment Questionnaire (HAQ) is ‘converted’ into utility using regression. The use of such transformed data by regulatory bodies which determine drug availability raises concern as it involves mathematical transformation between measures which may not be clinically equivalent and with potentially variable interrelationships over time.

We aimed 1) To assess characteristics associated with SF-6D and EQ-5D utility measures in EA 2) To check whether these associations are stable over 3 years.

Methods: – Patients: included in the French nationwide cohort of EA ESPOIR (at least 2 swollen joints for less than 6 months and suspicion of RA).

               – Data available: SF-6D and EQ-5D utility measures were longitudinally assessed in 813 patients with EA (at baseline, 6 months, 1, 2 and 3 years). Bio-clinical variables and X-rays were also recorded.

               – Analysis:  The determinants of SF-6D and EQ-5D utility measures at each time-point were assessed by multivariate linear regressions in 618 EA patients followed over 3 years. Partial R-squares were used to assess the relative importance of variables to the variation in EQ-5D and SF-6D scores.

Results: At baseline, SF-6D was essentially determined by function, HAQ explaining 50.2% of the variance, whereas after 6 months, SF-6D was essentially determined by mental status (the Arthritis Impact Measurement Scale 2–Short Form) (55.8 to 57.6% of the variance) and the HAQ represented only 7.3 to 13.2%. At each time-point, EQ-5D was essentially determined by function, HAQ explaining 36.9 to 44.2% of the variance, except at 1 year, it was essentially determined by mental status, explaining 40.8% of the variance and the HAQ only 11% (figure).

Conclusion: The major impact of functional ability and mental status, and the variability of the utility determinants over time in addition of the bimodal distribution of the EQ-5D raise concerns about mapping to estimate utilities from clinical instruments. Evaluation of treatment cost-utility should not be based on utility data transformed from HAQ.


Disclosure:

C. Gaujoux-Viala,
None;

A. C. Rat,
None;

K. Hosseini,
None;

R. M. Flipo,
None;

F. Guillemin,
None;

B. Fautrel,
None.

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